BACKGROUND: Online Medical Consultation (OMC) offers a promising avenue for improving healthcare access and efficiency in Iran. However, its integration into the national health system remains limited due to complex systemic, infrastructural, and regulatory challenges. OBJECTIVE: This study uses the Consolidated Framework for Implementation Research (CFIR) to identify and analyze the key facilitators and barriers to OMC adoption in Iran from the perspectives of healthcare policymakers and administrators. METHODS: This qualitative study employed semi-structured interviews with nine senior healthcare stakeholders. Data were analysed using inductive thematic coding, mapped onto CFIR domains, to systematically identify multilevel factors influencing OMC implementation. RESULTS: Key facilitators included perceived advantages of access and efficiency, Adaptability across healthcare functions, Recipient-Centred Transparency and Accountability, urban digital readiness, and increased acceptance during the COVID-19 pandemic. Barriers were identified across multiple domains, including weak infrastructure, lack of legal frameworks, limited digital literacy, Tensions between patient satisfaction and clinical standards, and absence of stakeholder engagement. CONCLUSION: OMC in Iran presents clear benefits but faces entrenched barriers requiring targeted policy, infrastructure, and educational interventions. Regulatory clarity, cross-sector governance, and integration with public systems are critical for sustainable scale-up.